| NPI | 1417058082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: OR MD12786) |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology (Licence: OR MD12786) |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: OR MD12786) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2013-10-04 |